Provider Demographics
NPI:1265411649
Name:VELTKAMP, TRENT D (DDS)
Entity type:Individual
Prefix:DR
First Name:TRENT
Middle Name:D
Last Name:VELTKAMP
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1610 GROVER ST
Mailing Address - Street 2:STE C1
Mailing Address - City:LYNDEN
Mailing Address - State:WA
Mailing Address - Zip Code:98264-1539
Mailing Address - Country:JP
Mailing Address - Phone:360-354-5691
Mailing Address - Fax:
Practice Address - Street 1:1610 GROVER ST
Practice Address - Street 2:STE C1
Practice Address - City:LYNDEN
Practice Address - State:WA
Practice Address - Zip Code:98264-1539
Practice Address - Country:JP
Practice Address - Phone:360-354-5691
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-12
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00009699122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist